Misuse of acetaminophen in the management of dental pain

Abstract

We propose that even patients with mild clinical symptoms with a supposed ingested dose of acetaminophen greater than 150 mg/kg/24 h should be referred to an emergency department and that liver enzyme activity should be analyzed. No case of liver failure was observed during our short survey. However, hepatotoxicity of repeated supratherapeutic ingestion of acetaminophen was suspected in four patients. Patients and practitioners should thus be better informed about the risk of unintentional acetaminophen overdose following supratherapeutic acetaminophen ingestion.

Менеджмент Хронической Постпроцедурной Боли В Стоматологии

“…Однак необхідно враховувати, що при неадекватному менеджменті постпроцедурного болю зростає ризик побічних ефектів. Зокрема, відмічено високу активність печінкових ферментів при застосуванні парацетамолу в середній дозі 137 мг/кг за 24 годи-ни [21]. Частіше побічні явища були пов'язані з використанням ацетилсаліцилової кислоти та опіоїдів [22].…”

Paracetamol Misuse and Dental Pain: Results from the French Observational DAntaLor Study

“…To standardize the ingested doses, the supposed ingested dose (SID) was determined as explained by Clement et al 9 using three values provided by the patient: the supposed period of ingestion (i.e. time elapsed between the first and last paracetamol intakes), the total ingested amount of paracetamol over the period of ingestion, and the weight of the patient.…”

“…[3][4][5][6][7][8] Paracetamol overdose associated with dental pain is mainly the result of unintentional repeated supratherapeutic intake rather than of intentional acute paracetamol exposure. 9 In this particular clinical situation, the risk of hepatotoxicity is hardly identifiable and it is not easy to recognize hepatotoxicity because clinical signs as nausea, vomiting or abdominal pain are mild and unspecific and the alanine aminotransferase (ALT) level can be normal or slightly elevated. 2,10 Furthermore, the risk of hepatotoxicity cannot be assessed by testing the plasma paracetamol concentration using the Rumack-Matthew nomogram -only validated for acute paracetamol poisoning with immediate-release oral preparations within the first 24 hours after ingestion -since liver damage can occur even if levels of paracetamol are undetectable.…”

“…2,10 Furthermore, the risk of hepatotoxicity cannot be assessed by testing the plasma paracetamol concentration using the Rumack-Matthew nomogram -only validated for acute paracetamol poisoning with immediate-release oral preparations within the first 24 hours after ingestion -since liver damage can occur even if levels of paracetamol are undetectable. [9][10][11] Summing up, the evaluation of hepatotoxicity following repeated unintentional paracetamol overdoses is far from obvious and administration of N-acetylcysteine therapy should be considered in patients with excessive paracetamol intake -10g/24h or 6g/24h over a period of 24h or 48h, respectively and 4g/day for patients with predisposing risk factors of hepatotoxicity (chronic ethanol misuse, dehydration, prolonged fasting) 12 -and presenting clinical manifestations of hepatotoxicity (abdominal pain, fatigue, anorexia, and fever) or paracetamol plasma concentration greater than 20 mg/L or elevated levels of alanine aminotransferase (ALT) that should be checked in case of suspected overdose. 10 If the risk of hepatotoxicity associated with unintentional repeated supratherapeutic ingestion of paracetamol is described, the risk of hepatotoxicity in patients taking this drug to control dental pain has never been assessed.…”

Urgent dental care use in the North East and Cumbria: predicting repeat attendance

“…2,3 Despite this, almost one-third of the UK population are so called 'problem-orientated attenders' , 1,4,5 only seeking care when they have acute dental pain or problems, often waiting over two months before doing so. 6,7,8 As well as affecting their quality of life, this also puts them at risk of serious adverse events such as unintentional paracetamol overdose 9,10,11,12,13,14 and life-threatening infections. 15,16,17,18 As problem-orientated attenders only seek care when they have acute dental pain, they frequently use drop-in services in secondary care, often on a repeated basis and for the same problem, 3,19 as well as presenting to other healthcare professionals including hospital (medical) emergency departments, 20,21,22 general medical practitioners 23,24 and other allied health professionals.…”